SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2015
Open to Public
Inspection
Name of the organization
Michigan UFCW Health & Welfare Fund
 
Employer identification number

38-2427401
Return Reference Explanation
Form 990, Part VI, Section B, Line 11 The Funds certified accountant prepares the form 990 and submits it to the third party law firm, who is authorized tro review the form by the Board of Trustees. Once reviewed by the law firm, the accountant submits the form to the IRS.
Form 990, Part VI, Section B, Line 12a-c The Fund annually requires Trustees and key employees to disclose any relationships that could give rise to a conflict of interest under the Conflict of Interest Policy regarding the Fund. Any identified potential conflicts are brought to the attention of the affected individual and appropriately addressed, including the person recusing himself or herself from any involvment regarding the affected entity or transaction. The Trustees and key employees are also encouraged to be watchful of conflict of interest issues and bring such issues to the attention of either the Chairman of the Board of Trustees or the third party law firm. Any identified conflicts of interest are dealt with by the Board of Trustees.
Form 990, Part VI, Section B, Line 15 All Trustees are uncompensated and each Trustee is appointed by the participating Unions or Employers under the Fund. The Fund has a related entity, Michigan UFCW Unions and Employers Administrators, LLC that was formed to provide administrative services for the Board of Trustees. The Board of Trustees is the sole member and owner of the LLC. The LLC has one officer, namely the Chief Executive Officer. The Board of Trustees sets the compensation for this individual. In setting the compensation, the Board of Trustees consults with the benefits consultant and third party legal counsel for benchmarking data for positions in similar type administrative firms. The Board of Trustees determine the salary and benefits of the Officer.
Form 990, Part VI, Section C, Line 19 The Fund is established and maintained pursuant to the Employee Retirement Income Security Act of 1974 ERISA. It operates in compliance with the reporting and disclosure requirement of Subtitle B, Part I of ERISA with respect to disclosure of its governing documents and financial information. No documents are available to the general public other than those financial statments made part of and required to be disclosed in governmental filings.
Form 990, Part VI, Section A, Line 1b Under the Employee Income Security Act of 1974 ERISA, all members of the Board of Trustees are considered fiduciaries. As such, they are required to act solely in the interest of participants and their beneficiaries and with the exclusive purpose of providing benefits to them. Thus, while certain members of Board of Trustees may not meet the definition of independent under form 990 reporting standards, all members are held under ERISA to a high fiduciary standard of conduct which requires them to act solely in the interest of participants and beneficiaries.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2015


Additional Data


Software ID: 15000290
Software Version: 15.3.0.0